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Monday, April 19, 2004

How depressing...

An article in The Washington Post this weekend discusses the lack of clinical evidence for the efficacy of antidepressants in children.

The use of antidepressants among children grew three- to tenfold between 1987 and 1996, data from various studies indicate, and a newer survey found a further 50 percent rise in prescriptions between 1998 and 2002. The explosion in antidepressant use occurred even though the vast majority of clinical trials have failed to prove that the medicines help depressed children.

The spike in prescriptions over the past five years has been especially sharp among children younger than 6, even though there is virtually no clinical trial data on these youngest patients.

Obviously, it's dangerous to extrapolate data from trials on adults to children — our bodies work differently and will not metabolize drugs in the same way. However, doctors are relying on anecdotal evidence to support their practice of prescribing antidepressants for children.

Paxil has been linked to suicidal behaviour, but psychiatrists cast doubt on the authority of the regulatory bodies by insisting that the suicidal behaviour stems from the underlying depression.

What the article fails to address, and to my mind the greater issue, is how many children are being prescribed antidepressants. How many under 6 years of age? How are they being diagnosed? How can you tell if your toddler has depression?

Is it moodiness? Listlessness? The occasional "inexplicable" bout of screams or tears? How does hopelessness manifest itself in a baby? Need an individual be aware of one's feelings, be able to name them, in order to experience them? How can you tell if the behaviour is biochemically based and not a learned product of one's environment?

The American Psychiatric Glossary entry for "depression" states the following: Depression in children may be indicated by refusal to go to school, anxiety, excessive reaction to separation form parental figures, antisocial behavior, and somatic complaints.

My gut tells me this is ridiculous. I'm fortunate, for the timebeing, in having a daughter who is expressively joyful. But, had depression had the social acknowledgement it has today as an illness, I fear that some 30 years ago my mother might've given me drugs — to overcome the shyness, to inspire more obviously extroverted behaviour, to get me off to school with less resistance.

Who is taking their children to psychiatrists, and why? It's finally dawning on some people that perhaps antidepressants are being overprescribed in adults. Is this just another symptom of our quick-fix society being extended to our children?

What child doesn't experience some of the symptoms some of the time? Are they really troubled by their "shortcomings," or is it the parents who perceive a problem? Are parents trotting their children off to the doctors for a pill instead of helping them discover a new hobby or going down to the park to run around? (Could I ask any more rhetorical questions?)

When, hypothetically, 50% of society is taking a pill so they be more up, more on, it stands to reason that the "deviant," down, introspective, "depressed" behaviour ought to be redefined to be incorporated into the range of normalcy. So what are the numbers?

There may yet come the day of soma, or, more likely, the mandatory speed and steroid injections at birth, the artificial jolt all of us will require in order to keep up with the breakneck demands of preschool.